<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket>
<wicket:extend>
    <h1 class="pageTitle">
        <wicket:message key="titel"/>
    </h1>
    <form class="form-horizontal" wicket:id="form">
        <fieldset>
            <div class="row-fluid">
                <div class="control-group">
                    <label class="control-label">
                        Omschrijving
                        <i class="icon-asterisk icon-purple"></i>
                    </label>
                    <div class="controls">
                        <input type="text" wicket:id="omschrijving"/>
                    </div>
                </div>
            </div>
        </fieldset>
        <fieldset wicket:id="labs">
            <div class="row-fluid">
                <legend wicket:id="naam"></legend>
                <table class="table table-striped table-bordered table-condensed">
                    <thead>
                    <tr class="headers">
                        <th style="width: 13%">Tenaamstelling</th>
                        <th style="width: 13%">Rekeningnummer</th>
                        <th style="width: 13%">Verrichting</th>
                        <th style="width: 13%">Tarief</th>
                        <th style="width: 12%">Aantal</th>
                        <th style="width: 12%">Subtotaal (voor correctie)</th>
                        <th style="width: 12%">Correctie</th>
                        <th style="width: 12%">Subtotaal (na correctie)</th>
                    </tr>
                    </thead>
                    <tbody>
                    <tr wicket:id="betaalopdrachtregels">
                        <td wicket:id="tenaamstelling"></td>
                        <td wicket:id="naarIban"></td>
                        <td wicket:id="type"></td>
                        <td wicket:id="tarief" style="text-align: right"></td>
                        <td wicket:id="aantal" style="text-align: right"></td>
                        <td wicket:id="subtotaalZonderDebets" style="text-align: right"></td>
                        <td wicket:id="debets" style="text-align: right"></td>
                        <td wicket:id="subtotaal" style="text-align: right"></td>
                    </tr>
                    </tbody>
                    <tfoot>
                    <tr class="footer">
                        <td colspan="7" style="text-align: right">Totaal</td>
                        <td wicket:id="totaal" style="text-align: right"></td>
                    </tr>
                    </tfoot>
                </table>
            </div>
        </fieldset>
        <fieldset wicket:id="huisartsenContainer">
            <div class="row-fluid">
                <legend>Betalingen aan huisartsen</legend>
                <table class="table table-striped table-bordered table-condensed">
                    <thead>
                    <tr class="headers">
                        <th style="width: 13%">Tenaamstelling</th>
                        <th style="width: 13%">Rekeningnummer</th>
                        <th style="width: 13%">Verrichting</th>
                        <th style="width: 13%">Tarief</th>
                        <th style="width: 12%">Aantal</th>
                        <th style="width: 12%">Subtotaal (voor correctie)</th>
                        <th style="width: 12%">Correctie</th>
                        <th style="width: 12%">Subtotaal (na correctie)</th>
                    </tr>
                    </thead>
                    <tbody>
                    <tr wicket:id="ḧuisartsRegels">
                        <td wicket:id="tenaamstelling"></td>
                        <td wicket:id="naarIban"></td>
                        <td wicket:id="type"></td>
                        <td wicket:id="tarief" style="text-align: right"></td>
                        <td wicket:id="aantal" style="text-align: right"></td>
                        <td wicket:id="subtotaalZonderDebets" style="text-align: right"></td>
                        <td wicket:id="debets" style="text-align: right"></td>
                        <td wicket:id="subtotaal" style="text-align: right"></td>
                    </tr>
                    </tbody>
                </table>
            </div>
        </fieldset>
        <div class="row-fluid">
            <div class="span12">
                <div class="form-actions clearfix">
                    <button class="btn" wicket:id="terug">Terug</button>
                    <button class="btn btn-primary" wicket:id="genereren"><i class=" icon-download-alt icon-white"></i>
                        Genereren
                    </button>
                </div>
            </div>
        </div>
    </form>
</wicket:extend>
</html>
